Presently in China, less than 20 percent of breast cancer cases are diagnosed at a very early stage and this will need to change and in China, the approach is transforming from disease-focused to patient-centered.
A recent example was covered by China’s ECNS at the Guangdong Academy of Medical Sciences and Guangdong People’s Hospital. They begin with the surgery of 37-year-old Dai Liflang who received a breast-cancer focused surgical procedure leaving her breast intact—a key part of her body and focal point of self-image and esteem. Dai Liflang’s surgeon, Liao Ning noted: “As a woman myself, I understand what complete and full breasts mean for a women’s self-esteem and sometimes their intimate relationships.” Liao practices at Guangdong Provincial People’s Hospital and was trained in Germany.
Dr. Ning’s perspective reflects a growing movement in China toward people-centered, patient-centric paradigm. This also reflects the massive sea change in demographics in China. In 2002 4% of China’s population was “middle class”—a decade later that number climbs to 31% representing over 420 million people—greater than the United States entire population according to one analysis.
Ms. Liflang was discharged from the hospital on June 7 which is the Dragon Boat Festival, a traditional event to remember Qu Yuan, an ancient historical Chinese poet, and politician and ultimately celebrate the summer solstice. Right at midsummer, Ms. Liflang has much to be thankful for—a new hope for life: cancer-free and “complete.”
Not all patients can have this optimal outcome. In most cases, they must go through radiation after surgery to prevent the return of cancer. Full mastectomies are less likely to require radiation afterward. Many factors must be balanced for the right decision.
Dr. Liao and colleagues at Guangdong Provincial People’s Hospital performed about 350 breast-conserving surgeries last year representing 25% of all breast cancer surgeries at the center reports ECNS.
China National Cancer Center
The China National Cancer Center (CNCC) reports that no more than 20 percent of breast cancers are diagnosed at a very early stage in China. CNCC follows cancer incidence rates, survival, and mortality via the collection and analysis of data from approximately 370 cancer surveillance centers nationwide. The data reveals great disparities between east and west.
Vast Regional and Economic Class Disparity
In China in the prosperous eastern cities (Beijing, Shanghai, etc.) have found similar outcomes as to those discussed here at Guangdong Provincial People’s Hospital. However, the national picture differs with less than 10 percent of breast cancer surgeries performed conserving the breasts—far lower than an average of 63 percent in the United States.
In vast swathes of more rural, western China the rate can be as low as 3 percent reports Dr. Liao. A great gap exists in China. The great new middle class is situated in the east leaving the majority of the land operating under a different reality from a health care perspective. Liao reminds of the total and complete “lack of competent breast cancer specialists is mainly to be blamed for the gap.”
Breast cancer patients have a five-year survival rate of more than 83% in China–Other developed countries totals 91%. China’s vast western regions will experience far less consistent early detection not to mention poorer treatment realities for elderly late-stage sufferers.
Mao Meets Adam Smith
China’s development occurs under a historically unique situation—a centralized, command and control inspired communist government with parallel, unrivaled and unfettered capitalistic scenarios and situations unfolding all over the place. Markets are everywhere and for everything. The social determinants of health unfold in a big way in China. A surgical procedure of the type discussed in this summary article costs between $6,000 to $12,000—far more than most Chinese can afford other than the elite and the burgeoning middle class in the eastern cities. Hundreds of millions can now access such a surgery in the prosperous eastern cities.
Breast Cancer Becomes an Epidemic
With a growth of 4 percent annually, breast cancer is China’s most common form of cancer. Xu Binghe, a top cancer specialist from the Cancer Hospital of the Chinese Academy of Medical Sciences, reports that the 4 percent figure is higher than the global average. Breast cancer is being detected at younger ages-from around 30 to a peak of 55.
ECNS reports that about 304,000 women were diagnosed with breast cancer in 2015—17 percent of all newly diagnosed cancer cases among women according to the National Central Cancer Registry. In that same year, 70,000 died from breast cancer, representing 8 percent of total cancer deaths.
Chinese physicians and investigators understand the importance of international collaboration especially with the United States Dr. Liao acknowledged. For example, the 2019 China-US Summit Forum on Breast Cancer recently opened in Guangzhou with hundreds of top breast cancer experts from the two countries compare notes.
Aside from recent trade tensions and general chest pounding, the two countries owe an obligation to the each other and the world to pave the path for a better tomorrow—and medical science including clinical research is a fundamental underpinning composite material of such a road.
Location of China’s Major Cancer Centers: East
The following are major cancer centers in China. They are all located on the prosperous east coast.
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences (southeastern part of Beijing)
- Sun Yat-sen University Cancer Center (Guangzhou)
- Orthopedic Oncology Surgery (Beijing)
- Beijing Cancer Center (Beijing)
- Fudan University Shanghai Center (Shanghai—established in 1931 the first hospital specializing in cancer in China)
- Tianjin Medical University Cancer Institute and Hospital (TMUCIH)
As it turns out China’s economic miracle has been extremely selective geographically and among demographic groups—despite possibly the most sophisticated centralized planning and governing structures and mechanisms around. As is clear in China, those women that live in prosperous cities have a far greater chance of being diagnosed for breast cancer and having a happier outcome than those that live in poorer western regions. With early detection and global best practices, women can experience far better outcomes. Now, what is the mechanism to bring high quality, state-of-the-art patient-centered care to western China?Source: Ecns